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Parkinson’s disease, what is it?
In people with Parkinson’s disease, the brain cells (neurons) that make dopamine die slowly.
Dopamine is one of the substances that allows neurons to transmit signals to other neurons. A lack of dopamine disrupts this transmission. Problems (disorders) then appear, for example in movements.
In the majority of cases, it is not known why these neurons die slowly. In rare cases, it is because of a genetic problem (genetic mutation).
The first signs of the disease usually appear between the ages of 50 and 70.
What is its frequency?
The disease affects both men and women. It is present all over the world. In Belgium, it is estimated that 30,000 to 35,000 people suffer from Parkinson’s disease.
How to recognize Parkinson’s disease?
Most frequent complaints
The most frequent complaints are:
- from tremors at rest (in about 3 out of 4 people);
- slow and smaller movements:
- you blink less often,
- you write more slowly, your handwriting is smaller,
- your steps become smaller and you walk more slowly, shuffling,
- you have the impression of being grounded (‘freezing’).
- from stiff muscles :
- your face is as if frozen, it expresses very little (‘Parkinson mask’),
- you speak monotonously and with a weak and husky voice,
- your arms remain bent,
- your arms do not move when you walk.
Other complaints
Other complaints may also be present:
- muscle pains;
- abnormal posture;
- tendency to fall;
- constipation ;
- erection problems (incapacity);
- dizziness when you stand up (orthostatic hypotension);
- urinary emergencies Where difficulty urinating ;
- salivation or discharge of saliva outside the mouth;
- difficulty swallowing ;
- oily skin ;
- decreased sense of smell ;
- behavioral disturbances during sleep (for example, very intense dreams, sleepwalking, cries during sleep, …);
- depression, lack of energy, emotions and enthusiasm;
- anxiety and memory impairment when the disease is more advanced.
Not all symptoms are present at the same time. Symptoms appear as the disease progresses. Stress can make symptoms worse.
How is the diagnosis made?
The doctor thinks of Parkinson’s disease in case of tremors, slowness of movement and muscle stiffness. He then realizes a neurological examination : he tests how well your brain and nerves are working.
At the onset of Parkinson’s disease, it is sometimes difficult to tell the difference from other diseases that cause the same symptoms (for example, essential tremors). Some medications can also cause side effects that resemble symptoms of Parkinson’s disease.
If the doctor thinks of Parkinson’s disease, he will refer you to a neurologist. If in doubt, he can order a CT scan of the brain.
What can you do ?
If you have the disease, it is important to stay in good physical shape.
Exercise every day for at least half an hour or, for example, 3 times 10 minutes. For example :
- to walk ;
- ride a bike ;
- to dance ;
- to swim ;
- do specific movements like in Tai Chi for example.
What can your doctor do?
Treatment for Parkinson’s disease includes medication and physical therapy. Treatment aims to relieve symptoms and improve quality of life.
Medications
- Levodopa decreases muscle stiffness and movement disorders. Prolonged treatment often results in involuntary movements and persistent muscle contraction. Lowering the dose may decrease these side effects, but the symptoms of Parkinson’s disease often increase as well.
In case of prolonged treatment, levodopa also works for a shorter time (the duration of action of taking the drug is shorter). - MAO-B inhibitors can be used alone or with levodopa. They enhance the effect of levodopa, which makes it possible to reduce the dose of levodopa and therefore reduce the side effects of levodopa.
- Entacapone prolongs the effect of levodopa (the duration of action of taking levodopa is longer).
- Dopamine agonists work a little less well than levodopa, but they work longer (the duration of action of taking a dopamine agonist is longer than that of taking levodopa).
Physiotherapy
Loss of mobility is a major problem in Parkinson’s disease. This can:
- interfere with the performance of activities of daily living;
- cause a greater risk of falling.
Your doctor will therefore prescribe physiotherapy.
What can you do with your physiotherapist?
Moving is important
People with Parkinson’s disease are less active. This is most often linked:
- mobility problems (motor skills) caused by the disease;
- for fear of falling.
However, not moving or not moving enough can have negative consequences:
- this increases the risk of other health problems, such as:
- heart disease,
- type 2 diabetes,
- osteoporosis.
- This accelerates the degradation of:
- mobility,
- of balance.
Accompaniement
Your physiotherapist can help you:
- prevent, stabilize or reduce the physical consequences of Parkinson’s disease from the onset of the disease:
- he advises you on exercises to be performed at home, in complete safety;
- it supports you in carrying out exercises to improve your physical condition, your daily activities and your balance.
- prevent the risk of falling;
- facilitate your daily activities such as walking, getting up from a chair, rolling over in bed or getting into a car,…;
- reduce possible pain in the neck, back or shoulders.
Exercise program
Your physiotherapist will adapt the exercises to your situation, taking into account the following elements:
- the stage of your disease;
- your motor problems;
- any other ailments or difficulties.
The exercise program can have the following objectives:
- encourage regular daily physical activity:
- tips for being more active at home;
- exercises supervised by your physiotherapist, possibly at home.
- facilitate your daily activities such as:
- your movements on stairs or narrow places in the house;
- your fine motor activities such as pressing keys, buttoning a shirt, writing legibly,…;
- improve your physical condition by focusing on:
- exercise endurance which reduces your daily fatigue and prevents cardiovascular disease;
- muscle building which facilitates your daily efforts (getting up and sitting down) and helps you maintain good balance;
- improve or maintain your flexibility through muscle stretching;
- prevent or delay balance problems associated with Parkinson’s disease;
- facilitate your walk and your movements:
- improve your walk (take big steps, swing your arms,….). The walking exercises can be done in the physiotherapist’s office (for example on a treadmill), at home, or in places where you will learn to manage difficulties;
- learn to manage complex situations such as changes of direction, departures, stops, narrow environments, or even walking while performing another activity at the same time (talking, carrying a glass of water, etc.).
- improve your independence during activities such as:
- get up from a seated position and sit down safely;
- roll over in your bed;
- to dance ;
- do 2 things at the same time (double task).
- correct your posture if you stand hunched over.
Other treatments
Your physiotherapist can also offer you treatments such as:
- therapy that uses water (hydrotherapy);
- the use of heat or cold to combat pain;
- massages;
- relaxation, ….
Want to know more?
- Parkinson’s Association (Belgium)
- France Parkinson
- Parkinson’s: learning to live with the disease – mongeneraliste.be – SSMG – Scientific Society of General Medicine
Medications
- Antiparkinsonians – CBIP – Belgian Center for Pharmacotherapeutic Information
- Levodopa – CBIP – Belgian Center for Pharmacotherapeutic Information
- MAO-B inhibitors – CBIP – Belgian Center for Pharmacotherapeutic Information
- Entacapone – CBIP – Belgian Center for Pharmacotherapeutic Information
- Dopaminergic agonists – CBIP – Belgian Center for Pharmacotherapeutic Information
Are you looking for more specialized help?
Sources
- Foreign clinical practice guide ‘Parkinson’s disease’ (2000), updated on 08/30/2017 and adapted to the Belgian context on 12/19/2017 – ebpracticenet
- CBIP – Belgian Center for Pharmacotherapeutic Information
- Keus SHJ, Munneke M, Graziano M, et al. European Physiotherapy Guideline for Parkinson’s disease. 2014; KNGF / ParkinsonNet, the Netherlands
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